Uterine prolapse

OBG

1. UTERINE PROLAPSE
NAZNEEN VAHORA
CLINICAL INSTRUCTOR,
MTIN,CHARUSAT

2. UTERINE
PROLAPSE

3. INTRODUCTION:
•It is one of the common
clinical condition met in day to
day gynaecological practice
•It is most often seen in
multiparous women.
•It is a form of herniation.

4. Supports of uterus:
•Round ligaments
•Broad ligaments
•Pubocervical ligaments
•Pelvic floor muscles
•Utero sacral ligaments

5. ETIOLOGY:
•It includes pre-disposing & aggravating factors
1.Pre-disposing factors:(acquired & congenital):
a)Acquired:
•Overstretching of utero-sacral ligaments:
premature bearing down, forceful traction by
forceps or ventouse, prolonged 2
nd
stage of labour,
etc
•Overstretching of perineum
•Imperfect repair of perineal injuries
•Neuromuscular damage during childbirth
•Repeated childbirths.

6. b) Congenital:
•Congenital weakness of supporting
structures is responsible for prolapse in
nulliparous women.
2. Aggravating factors:
•Post menstrual atrophy
•Increased intra-abdominal pressure
•Undernutrition/over nutrition
•Fiboid uterus

7. TYPES OF UTERINE PROLAPSE:
1.Uterovaginal prolapse:
•It is the prolapse of uterus, Cx & upper vagina.
•Commonest type
•It is accompanied by Cystocele.
2.Congenital prolapse:
•No cystocele
•Often seen in nulliparous, so called as
nulliparous prolapse.
•Cause-congenital weakness of supports of Us.

8. DEGREES OF PROLAPSE:
First degreeSecond degree
Third degree
Here Us
descends
down from its
normal
position, but
ext. os still
remains inside
the vagina
The ext. os
protrudes
outside the
vaginal
introitus but
the uterine
body still
remains inside
the vagina
The uterine
body descends
to lie outside
the vagina.

10. PATHOLOGICAL CHANGES:
•Vagina: mucosa gets stretched, & dry,
infection leads to purulent discharge.
•Decubitus ulcer: cracks infection sloughing
ulceration
•Bladder: incomplete emptying due to sharp
angulation of urethra, cystitis.
•Ureters: they are pulled downwards, pyelitis
•Carcinoma: rarely develops on decubitis ulcer

11. SYMPTOMS:
•feeling of something coming down per vag
•Backache or pelvic pain
•Menstrual irregularities
•Dyspareunia
•Difficulty in urination, incomplete
evacuation, urgency, frequency, dysuria.
•Bowel symptoms: difficulty in
defeacation,

12. DIAGNOSIS:
•H.C
•Rectal exam
•Pelvic exam palpation of bulge
•Vaginal exam
•USG
•X-ray
•MRI

13. MANAGEMENT:
•Preservative, Conservative & Surgical
1.PRESERVATIVE:
•Adequate ANC & INC: avoid injury, slow
delivery, avoid forceful forceps/ventouse.
•Adequate PNC:early ambulance, exercises
•General measures: avoid straineous
activities, chronic Cough, constipation,
repeated pregnancies at short intervals.
•Manipulation in emergency cases.

14. 2. CONSERVATIVE:
PESSARY TREATMENT:
•Indications are:
–Early pregnancy(placed till 18 wks)
–Puerperium- to facilitate involution
–Pts absolutely unfit for surgery
–Pts unwilling for operation
•Disadvantage: the pt may feel so comfortable
that she may refuse for surgery

15. 3. SURGICAL:
•Indications:Failure of conservative treatment
•Types: a) Restorative: correction/ using grafts
b) Extirpative: removal
c) Obliterative: closing the vagina
•Colporrhaphy: if cystocele/urethrocele is present
•Pelvic floor repair
•Fothergill’s or Manchester operation: it is
done when one desires to preserve the
reproductive system
•Hysterectomy

16. Complication of surgery:
•Haemorrhage
•Trauma
•Shock
•Infection
•Urinary complications:
incontinence/retention
•Recurrence of prolapse
•VVF following bladder injury
•RVF following rectal injury

17. Thank you..!!